SPinMD: Feeling "Normal" Again

[SPinMD]

Hi all,

 

Lurker for awhile, first time poster. I was on 30mg of Cymbalta (duloxetine) daily for one year for depression and chronic pain/fatigue. I felt some marked improvement about five days in for maybe a month. Eventually the honeymoon kinda wore off and it was back to baseline feeling. My doctor offered to increase my dose, but I'd always been hesitant go on an SSRI/SNRI to begin with, so I declined, instead managing breakthrough symptoms with tramadol and some herbal supplements. Spring came, along with a new job, and I started doing a bit better - pain was worse, but moods were a lot better.

 

About 6 months after starting Cymbalta, though, I suddenly started piling on weight. For no apparent reason - my diet did not change at all. 30 pounds in 6 months took a big toll on my self-esteem. After doing some research, I realized this weight gain is common on Cymbalta. Additionally, I'd often get horrible anxiety for about 2-3 hours upon awakening, akin to drinking too much coffee. Not a feeling of generalized anxiety, but just a terrible jittery feeling. One day just under a month ago I said "eff this" and decided to just quick taking it cold turkey. I knew going into it that it wouldn't be easy, but I'm stubborn The worst of the physical withdrawals were over in about 7-10 days. It was pretty brutal (brain zaps, dizziness, horrible vivid nightmares, hot and cold flashes, terrible mood swings, etc.) but I managed. 

Here I am, though, on day 26, and while I am no longer zapping or feeling sick (and am grateful for that!), I simply do not feel like myself emotionally. I do much worse in the winter than in the nicer months, and it's been a rough winter here in Maryland, so I am sure that hasn't helped, but overall I felt decent enough in the months preceding quitting Cymbalta.

 

I am pretty certain this feeling of rebound depression is from the sudden discontinuation, since I have no reason to be feeling depressed otherwise. It's hard to explain exactly how I feel, but it's a mixture of lethargy, apathy, fatigue, brutal insomnia, and just overall feeling "blah". Not really "sad", but I just have a hard time getting excited or caring about anything. 

The frustrating thing is that I felt for awhile I was doing better after the physical WD's stopped. I had a period of close to two weeks where I overall felt pretty good and felt like I was on my way to "normalcy". But now I've been feeling crappy like I described for the last four or five days in a row, and I'm getting frustrated and scared. When am I going to feel better? What's going on? Is this normal? 

 

I absolutely refuse to go back on any antidepressant. Ever. I saw my doctor about ten days ago (she's great!) and she was super cool about me going off Cymbalta, but at the same time, she doesn't have the same view of antidepressants that I've acquired through research (efficacy rates no better than placebo, the horrible withdrawals, etc), so I fear there's not much the doctor can do. 

 

I guess I just came here to vent to people who will understand and can maybe provide me with some guidance. I'm sure someone will ask about my supplement regimen - I've been taking 750mg of DLPA and a B-Complex w/ folate when I wake up, and 2000mg of fish oil and 6000 IU of Vitamin D at night. I was taking 400mg of Sam-E in the AM and 400mg of magnesium citrate at night until about a week ago, but I stopped both due to sudden stomach issues. Stomach issues persisted for several days, so in hindsight, I think it may have been a bug, so I plan on reintroducing Sam-E tomorrow. 

 

Thanks in advance to anyone who reads this and provides input. You have a great community here and I'm glad I am not alone in this struggle.

[Petunia]

Welcome SPinMD,

Thank you for joining and posting an introduction. I moved your post here to start your introduction/update topic. You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want. Its a good idea to bookmark it or follow it, so its easy to find again.

 

I'm sorry to hear that you have not been feeling well since stopping Cymbalta, part of the reason may be because you stopped cold turkey, rather than tapering, these kinds of medications need to be tapered when you want to stop.

 

We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?

 

I think some of what you are experiencing now could be attributed to withdrawal, its impossible to say how long this will last. You could be feeling better in a few weeks, but for some people, withdrawal can go on for months and even years in some cases.

 

See: What is withdrawal syndrome?

 

Reinstatement of a small amount of the drug can often work well to alleviate withdrawal symptoms. According to medical knowledge, reinstatement is the only way to alleviate withdrawal. Reinstatement is best done immediately upon appearance of symptoms. The more time that passes, the less likely it is to work. Once you have stabilized on a low dose of the drug, then a slower, safer taper can be started. Here is some information about reinstatement to help you decide if its something you would like to try:  About reinstating and stabilizing to stop withdrawal symptoms

 

I know you don't want to go back on an antidepressant, and that's understandable, but its something to consider. It would only be a small amount, maybe 10mg would be enough. This topic gives you information about how to divide your pills and take a smaller amount:  Tips for tapering off Cymbalta (duloxetine)   Then when you were stable, you would begin a slow, safe taper.

 

The only other advice I can give you is to perhaps start taking your fish oil and vitamin D in the mornings, both of those can be activating and may be effecting your sleep. You also may feel better when you start taking the magnesium again, at night, it can often help with sleep. If you find the citrate causes upset, changing to glycinate may help, its better absorbed.

 

Here is the link to our symptoms and self care section, you may find some useful ideas to help manage symptoms as you recover.  Especially read the topics pinned at the top.

 

Please stay in touch and let us know what you decide.

 

Petunia.

[KarenB]

Hi SPinMD,

 

Just chiming in to agree with Petunia that a small resinstatement would probably be the path of least pain and best outcomes.  I'm sure other members who have tried to ride it out will add their voices too.

 

Also, we totally understand your resistance to it.  It's nasty stuff, and taking it again feels totally and utterly wrong.  

 

Welcome to s/a,

Karen 

[SPinMD]

Thanks, Petunia and Karen. I will certainly start taking all my vitamins in the AM, I had not thought of that. I'm hoping reinstating Sam-E will help, too.

 

As for reinstating Cymbalta - I just don't think I can bring myself to do it. I really wish I knew what exactly was going on in my head (don't we all?) because on one hand, Cymbalta has a crazy short half-life, so that leads me to believe this is simply rebound depression from the cold turkey plus winter time, and poor sleep probably isn't helping. But at the same time, I recognize that many people have long-lasting withdrawals, so it could simply be that. I don't know. What I do know is that crap has been out of my bloodstream for 3+ weeks now, and I just fear that reintroducing it would be playing havoc on my brain again. 

 

I have read that a common means of tapering with SNRI's or anything with a short half-life is tapering from the SNRI to something with a long half-life, usually Prozac because it's well-tolerated compared to many others, and then slowly tapering from that. What are your thoughts on this? I would be more open to trying either that or maybe Wellbutrin since (at least anecdotally) I hear those are among the easier ones to taper with less side-effects (I'm sure that's not true for everyone). 

 

I must remind myself that this is temporary and at least I was only on it for a year, so it likely won't take too long for me to get back to "normal" (whatever that is), but not knowing what's going on in your head when you're the type of person who needs absolute control of their life is really frightening and disheartening.

[KarenB]

Yeah, it's a horrible place to be in.

 

You may not know that it's not so much the length of time it's been out of your blood stream, but the length of time it will take your brain to re-adjust back to it's original condition.

 

That's a lot slower.  Think of it like a slow re-growing than a quick flushing out.  Rhi put it way better than I can:

 

It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain.

 

Link for the whole explanation is here:  http://survivingantidepressants.org/index.php?/topic/1160-how-psychiatric-drugs-remodel-your-brain/

 

I've gotta go to bed now, but will write more later.  Or someone else will .

 

Karen

[AliG]

You are lucky to be in a place where reinstatement is still possible .  I would have a good , hard think about this.  Yes, it's nasty , but what is worse is months of drawn out withdrawal . Reinstatement , is the only way to relieve symptoms. Other than that , it is an exercise in patience and time.  It's not a great place to be , as there is no alternative, once you are beyond the point of " turning back ".  Have a good , long hard look at this , before turning your back on reinstatement .

Just because you were on for a year , doesn't mean much .  We have members who only took 1 - 5 pills !!  ( Now in prolonged withdrawal ) .

[Altostrata]

Welcome, SP.

 

That feeling of emotional anesthesia and demotivation is a very common consequence of taking an antidepressant.

 

Do you have any other withdrawal symptoms now? How is your sleep?

[SPinMD]

Welcome, SP.

 

That feeling of emotional anesthesia and demotivation is a very common consequence of taking an antidepressant.

 

Do you have any other withdrawal symptoms now? How is your sleep?

Thank you!

 

The physical symptoms are all pretty much entirely gone. I occasionally still get hot flashes, but that's about it. The brain zaps are all gone, the nightmares are gone, the dizzy spells and flu-like feelings are a distant memory. Thankfully it really only took about 7-10 days for all of the physical symptoms to go away. 

 

My sleep the last several days has been horrible. I've always struggled with bouts of insomnia. It goes in cycles, usually lasting for about 3-5 days before I finally get really exhausted and just break the cycle and get a good night's sleep. This one is particularly nasty, though. I haven't gotten more than 6 hours of sleep in about 5 days, despite feeling lethargic and exhausted all evening. It's hard to describe; not like a typical bout of insomnia where I get anxious about being unable to sleep and have a tough few days. This time, it's just like, my brain won't shut off. My thoughts don't race like they normally do when I'm having insomnia. i just....lay there, in a drowsy, blank mindset for 2-4 hours before finally passing out. I'll admit that I sometimes get frustrated, get up, and take a couple shots of whiskey if I just can't stand it any longer, which always knocks me out right away, but I know this isn't healthy so I try not to do that much.

 

I'm certain that my sleep problems aren't helping the anhedonia, but I've gone through dozens of insomnia bouts even worse than this where my emotional state isn't affected the next day, save for some anxiety, which poor sleep can trigger for me.

[Altostrata]

Sleep disruption is very common in withdrawal syndrome. See Important topics about symptoms, including sleep problems

 

Many people do better with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

Is your life situation low-stress?
 

[SPinMD]

I've been taking 2000mg of fish oil since going off. I was taking 400mg of magnesium citrate, but developed stomach issues about a week ago so I stopped, thinking it may have been the culprit. The stomach issues have lingered, leading me to believe they're either an annoying/strange lingering Cymbalta WD symptom, or perhaps a food-borne illness that's lingered due to the symptoms and longevity. 

 

It's low-stress in the traditional sense, yeah, I'm low-stress right now. I'm a full-time student taking online classes through a public university, but school comes naturally to me. I'm going back to work just two days a week at the store I used to be an assistant manager of, because my old boss and I have a good relationship and she needs help right now. I figured that will be good for me, getting out of the house and being social. Otherwise, I'm blessed to be able to say besides my health issues (in addition to this mental BS, I've been a type 1 diabetic since age 9), I have a pretty chill life right now.

[AliG]

You sound confident . I hope it keeps up for you . 

 

"I must remind myself that this is temporary and at least I was only on it for a year, so it likely won't take too long for me to get back to "normal" (whatever that is), but not knowing what's going on in your head when you're the type of person who needs absolute control of their life is really frightening and disheartening."

 

Unfortunately , there is no guarantee.

[SPinMD]

You sound confident . I hope it keeps up for you . 

 

"I must remind myself that this is temporary and at least I was only on it for a year, so it likely won't take too long for me to get back to "normal" (whatever that is), but not knowing what's going on in your head when you're the type of person who needs absolute control of their life is really frightening and disheartening."

 

Unfortunately , there is no guarantee.

 

I have learned in my short time on this earth, dealing with both physical and mental illness, that a little optimism goes a long way.

 

I hope you do the same.

[shelbytrev]

I have been off Effexor for three months and Prozac for about 5 weeks. Symptoms are changing all the time. I kinda freaked out after the psych told me Prozac can take up to 5 weeks to be out of your system. Anyhow , my latest symptom is hearing words in background noise. For example today I heard "hey" out of the dishwasher noise. Well I freaked myself out last night googling that symptom and early stages of psychosis came up. And on and off during the day I hav been getting this really weird feeling. Like my life feels different or weird. I try not to pay too much attention. But it's kinda starting to bother me. Im so sensitive right now , my husband changed the light bulbs in our house which made it brighter. It kinda freaked me out. It felt so different. I'm not sure if this is just anxiety or coming off the meds is altering my perception of reality. I feel anxious on and off throughout the day just based on the weather. Like I'm paying too much attention to myself now. I'm having all these weird feelings and thoughts or flashbacks triggering anxiety or weird feelings. Is this normal?? I feel like I'm going insane ? But then there are spurts during the day where I feel ok. It's worse when I dwell on my feelings or I'm tired.